Amino Acid Therapy for Depression, Part I: The Fix for Anxious or Agitated Depression

While uncovering the root cause of depression can often be complicated, there are times when one supplement just saves the day.

That’s what happened when Annie came to see me:

Annie was only 24 years old and already a veteran of the mental health system.

She had been hospitalized four times during her adolescence and young adult years with depression, anxiety and an eating disorder.

When we had our first appointment, she was struggling to eat enough calories (usually only one meal a day, and mostly just carbs, “because it’s all I can eat without puking,”) her mood was low and negative and she often obsessed about cutting herself. Also, she had panic attacks every few days and couldn’t get to sleep without a few shots of bourbon (because “I can’t get my mind to calm down”).

She was increasingly hopeless and was pretty sure that things would never get better.

Part of her lack of optimism was because she felt like her psychiatrist had given up on her. He had prescribed her most of the antidepressants available over the years, and nothing seemed to help much.

After our first phone call, I felt pretty confident I knew ONE thing that would help her.

It’s Easy to Find What You’re Looking For If you Know Where to Look

The first step in the mental health nutrition work I do with people is to assess their neurotransmitter (NT) deficiencies using a tool designed by nutritional mental health pioneer Julia Ross MA, called the Amino Acid Therapy Chart.

It gives you a quick and accurate window into their NT deficiency symptoms and then provides guidance into what amino acids will likely be helpful.

Amino acidsare what’s left after protein is broken down in the body by digestion. For many decades, nutritionally minded mental health practitioners have been using these natural substances as targeted interventions to address symptoms including depression, anxiety, ADHD, OCD and others.

I use amino acids every day in my practice and can’t say enough about how quickly and powerfully they can work to address mental health symptoms when NT deficiencies are the issue.

So then what are neurotransmitters?

Neurotransmitters are communication chemicals that serve as the main mood regulators in the brain. Low (or sometimes high) levels of the chemicals are responsible for most mood and behavioral issues.

There are four main neurotransmitters involved with mood and behavior: Serotonin, Catecholamines (Dopamine/Norepinephrine), GABA and Endorphins. Low levels of each of these, lead to a very specific pattern of mental health symptoms. Take a look to getsense of the common symptoms related to each deficiency.

While all four neurotransmitters are important for understanding a person’s mental health in general, only two play a significant role in depression: Serotonin and the Catecholamines (affectionately referred to at the “CATS.”)

It’s interesting that while low levels of Serotonin and CATS both lead to depression, the kind of depression that result from deficiencies of each are quite different.

Here’s the basic rule:

Low Serotonin= anxious depression

Low Catecholamine= low energy/ low motivation depression.

I usually refer to depression resulting from low level of the CATS to be an “Eeyore depression” (that’s right, from ‘Winnie the Pooh.’) Think of Eeyore dragging and moping and you get a good picture of what a low CATS depression is like.

So back to Annie.

As I listened to her case, ONE neurotransmitter deficiency just jumped right out at me, and I bet by now you can guess which one!

Here were my thoughts after our first appointment:

She was extremely low in serotonin, as a result of being malnourished (remember she had barely been eating for years because of her eating disorder).

NONE of the antidepressants she had been taking over the years worked because she didn’t have enough serotonin in her brain (because of low levels of amino acids, there were no building blocks to make serotonin.) A little know fact is that antidepressants don’t make new serotonin, they just make better use of the serotonin available in the brain. So if there isn’t enough serotonin in the brain to begin with, antidepressants won’t work well. Click here to learn more about antidepressants.

Just so we are on the same page about low serotonin symptoms, here’s a list:

Negativity

Depression

Worry, Anxiety

Low self esteem

Obsessive thoughts or behaviors

Controlling

Perfectionism

Irritability

Panic attacks; phobias

Suicidal thoughts

Insomnia, disturbed sleep

Does it surprise you that low serotonin was the first thing that jumped out at me when thinking about Annie?

The Two Fastest Steps to Address Serotonin Deficiency

If you identify with three or more of the Serotonin symptoms listed above you might want to consider these steps.

1) Make sure you are getting enough protein.

When protein is digested, it’s broken down into 20 different amino acids to be used in the body. Nine of these amino acids are called “essential” because they are needed, but can’t be made by the body.

One of the these is L-Tryptophan (you have probably heard that it’s in “turkey,”) but it’s also in many other foods with protein.)

L-Tryptophan and its derivative, 5HTP (5-Hydroxytryptophan), are the only two things on the planet that Serotonin can be made from!

Since L-Tryptophan is only available from food with protein it’s essential to be eating enough protein if you are depressed.

Also, it can be helpful to focus on foods high in Tryptophan, because not all foods containing protein have the same amino acid compositions. Here’s a list of foods to focus on.

2) Supplement with L-Tryptophan or 5HTP

The easiest and fastest way of building up levels of these Serotonin precursors is to take them as nutritional supplements. These are very common supplements that can be purchased at Whole Foods or any health food store.

In my practice I have found them to be the MOST POWERFUL treatment for depression by far.

When they are the right supplement, at the right dose, they are like magic!

Which do you start with?

I usually have people start with 5HTP because it’s easier for the body to convert it into Serotonin (only one step away.). If for some reason someone doesn’t respond as well as hoped for, I have them switch to L-Tryptophan.

In my experience, about as many people respond to 5HTP as L-Tryptophan, but it’s not uncommon for someone to have a powerful response to one but not the other. So if you how low serotonin symptoms, start with one and if don’t get benefit, try the other.

How do you know how much to take?

I find that dosing is the most confusing and frustrating thing about taking amino acid. I can’t tell you how many people come to me saying they have tried amino acids and they “didn’t work.”

The most common reason for amino acids not working besides the person not needing them, is that they took them at the wrong time of day or took too low of a dose to be effective.

Click here for a detailed explanation of how to find the right dose of L-Tryptophan and 5HTP.

If you decide to work with either of these, please follow the dosing recommendations carefully. It may make the difference between a robust response or a disappointing experience.

IMPORTANT NOTE: If you are on an ANTIDEPRESSANT medication, don’t take either of these supplements without consulting with a trained professional skilled in Amino Acid Therapy. Speak to a medical professional before starting any nutritional supplements.

Annie’s L-Tryptophan Experience

Once I was pretty clear that her issue was low serotonin, I suggested that she try L-Tryptophan with some zinc and vitamin b6 (these are both cofactors that are essential for converting tryptophan into serotonin. Because of her panic and anxiety, I decided to try Tryptophan first because 5htp can raise cortisol in some anxious people.

She followed the dosing recommendations that I provided above. Over the first few days she didn’t feel much and become disillusioned.

With some encouragement she continued increasing her dose. When she got to 1500 mg of L-Tryptophan twice a day, something amazing happened.

Her depression which has been at a constant 8 for many years (on a 1-10 scale, with 10 being suicidal) went down to 4. Her anxiety which had been at a 7 went down to a 3 and her panic attacks went from 3 or 4 times a week to once a month.

This was the first shift in her symptoms that she had experienced in many years and gave her the encouragement and optimism to really start working in her therapy (which she has been in for years, but found it to be very unproductive).

After a few months she was able eat more normally again.

Annie check in with me two years after discovering tryptophan. She had been in the first romantic relationship she had ever been in and was moving to a city with her new boyfriend, hours from her parents (a development she never imagined possible.)

Though life was not perfect, she was happy much of the time, and felt like she was heading in the right direction.

Now What About You?

I know that some of you are thinking that this kind of response is too good to be true. I promise these kinds of reaction DO happen but clearly not every time.

If the symptoms of low serotonin listed above “feel” like you, I would urge you to give 5HTP or L-Tryptophan a try.

If you don’t notice any positive response to one, move on to the other. I can’t tell you have many times I have seen one not work, and then the other be just the right thing. You just never know which is going to be better.

If you decide to experiment with their 5HTP or L-Tryptophan share your experience either in the comments section below or on my Facebook page.

What do you have to lose?

If it doesn’t help, you’re only out the cost of the supplements, which would be less than a $20 experiment. If it does, you may feel like you won the lottery!

If you enjoyed this post and would like to receive more of my blogs, please add your name to my mailing list at MoodHealing.com.

Dr. Josh Friedman has more than 25 years experience in mental health as a client, psychologist, and functional nutrition practitioner. After working in the field for a few years, he realized how many people were still struggling with depression and other mental health issues even after years of therapy and medication. Over time he became increasingly uncomfortable with the limitations of standard psychiatric treatment and knew there had to be a better way. Over the past decade and a half, he has committed himself to learning as much as he could about the root causes of mental health symptoms. To share this information and to help people get unstuck, he started Alternative Mental Health Solution.

Hi Josh, Thank you for posting this article. I have been suffering with chronic generalized anxiety since 2001, and have been on various antidepressants and benzodiazepines. I am currently on citilopram 10mg and clonazepam (1/2 tab per day). It takes the edge of my anxiety and controls my extreme OCD symptoms but I have some sleeping issues including restless legs. I experience a lot of body tension and what I describe as stinging or rawness over my body. I also get tired and stressed very easily. I currently take 1 GABA and high amounts of DFH stellar C per day. I am currently low in B12 and D but seem to react when supplementing. I also react to 5htp. I follow a paleo style diet eating only grass fed meat and wild fish. I do hot yoga 3 times per week. I actually work as an osteopath but practice more functional medicine helping people recover from chronic pain issue through fm principles. I have tried to come off my different medicine three times. But only crashed the last time 4 years ago being the worst which I have been slowly climbing out of. I have suffered from anxiety from childhood when I developed a severe stutter and also my mother was on Valium during that time. So I know I have emotional issues to work through but also feel chemically I am off. Two other notes I also have v low glutathione based on a organic acids test and have a chronic fungal issue – fungal toes – that I control with diet. I am thinking about trying the l tryptophan as 5htp did not agree with me. Any thoughts would be greatly appreciated.

Thanks for reaching out. Tryptophan makes sense to try. I would start off at (1) 500mg cap 4 times a day away from food. I would dose up accordingly using the PDF that the article links to about dosing. If you find it helpful I would also add Inositol for the anxiety and OCD. Typically dosing is 1 tsp 3x day but you want to start low and dose up. Based on your symptoms I might also look into the work of Dr. Bill Walsh who has identified key underlying factors in mental health. These include looking into methylation status (testing for Whole Blood Histamine), Zinc/copper ratio and Pyroluria. There is much info on the web about the underlying issues.

Dr. Friedman, Thank you for your very informative article. I read Dr. Ross’ book and have tried implementing for myself with limited success and I am back on an antidepressant, unfortunately, but I probably did not take enough of the amino acids. I am writing today for my 11 year old son. I do not want to put him on an SSRI but his doctor is recommending one. He already takes ADHD meds which could make anxiety worse. His anxiety symptoms started after my husband passed away (his step dad) and it got even worse when his biological dad suddenly passed away, also. He has a lot of fears about his own death and death of loved ones, etc. My question is: are there gummy flavored amino acids? and will it be effective if he takes the 5htp or tryptophan when he gets home from school at 5pm and then before bedtime? He can’t bring meds to school and he doesn’t swallow pills. Please advise. Thank you.

For starters my condolences to you. For you it may be best to find a skilled practitioner to work with to make sure your choices of aminos were right and the dosing (as well as making sure you have the necessary vitamins and minerals to create the wanted neurotransmitter). For your son, so sorry he is going through so much. The best brand of tryptophan is by Lidke. They have a chewable maple-vanilla flavored tryptophan. I would start with that and do 1/2 of one at 5 and 1/2 hr before bed. And then see how he does with 1 at each of those times. If he is older than 7 you could probably go up to 2 at at time (which would be 400mg each dose) but seeing where he feels the best. Here’s a link to that product. Lidtke also has an apple flavor chewable.

I’ve been experiencing a sense of ’emptiness’ for about 4 months. I don’t feel happy or excited but i also don’t feel sad or anxious. I’ve decided i would like to try 5-htp to potentially help bring back some of these emotions and start feeling normal again, so I’ve purchased a 5-htp 200mg time-release bottle and have begun the course this morning. How long would you recommend i should take 5-htp before i decide if it has been effective? In other words, how long should i take 5-htp before (if) considering making the switch to L-Tryptophan?

Daniel, How was the 5htp trial? Typically I have people start with 50mg mid afternoon and bedtime (or in some cases adding 1st thing in the am and mid am) and dosing up from 50mg 2 or 4x day and dosing up from there. It is important to find the right dose. Often it’s lower than 200mg a dose.

Daniel, How was the 5htp trail? Typically I have people start with 50mg mid afternoon and bedtime (or in some cases adding 1st thing in the am and mid am) and dosing up from 50mg 2 or 4x day and dosing up from there. It is important to find the right dose. Often it’s lower than 200mg a dose.

Thank you so much for this article. I’m one of the people you mention who tried 5-HTP years ago, and thought that it didn’t work for me. I had an eating disorder for almost 20 years (it went away about 4 years ago) but for the past several years, I’ve had mild depression and pretty severe sleep issues. I’m curious if you think I should try the 5-HTP or the L-Tryptophan first?

I also have a question about the dosing. You said to take them 20 minutes before or 90 minutes after food with protein – is that an “at least” 20 minutes before/90 minutes after? Or “at most”? Or does it need to be pretty exact?

I would probably start with 5htp again. Not sure what type of Eating Disorder you had but if it involved being undernourished, it’s possible that it didn’t work because you did not have enough of the vitamin/mineral cofactors coming from the food you were eating to convert the 5htp to serotonin. Also, it may have been a dosing issues. There is definitely a sweet spot in dosing 5HTP or Tryptophan where too little won’t work and too much there will be side effects. In terms of the timing of the dose, it’s “at least” 20 min before or “at least” 1 1/2 hrs from protein. The issue is that the amino acid is not competing with other proteins for digestion.

Great Article! Thank you! I am wondering if I feel I am low in catecholamines what would I supplement with? I read that L-Tyrosine is a precursor of catecholamines, is it safe to supplement with that? Thank you 🙂

Hi Lynne, The 2 most common ways of boosting the CATS would be L-Tyrosine or DL-Phenalanine (DLPA). Start with 1 or there other. If in addition to low energy and mood you have a sensitivity to emotional or physical pain, I would start with DLPA. If not start with Tyrosine. Start with one and if it does not alleviate symptoms you can switch to the other. They are both typically dosed 1st thing in the AM, Mid Morning and possibly mid afternoon starting with 500mg each dose. If you feel better or feel nothing double the dose each time. You are looking for the “sweet spot” where you are feeling less depressed or low energy and feel worse when you try to raise the dose again. I would not go any higher than 2500mg per dose.

Dr Josh, I have been fighting against suicidal depression for a year. But recently it seems like it is even worse. In your experience and practice, could taking tryptophan in higher doses make it worse? I have been diagnosed pyroluria, undermethylator, and all that so I am taking Zinc, p5p, and such but nothing is improving. I decided to try tryptophan and upping it but I am just not sure if it is going to work. Just wanted to know if tryptophan could make it worse and if so, should I be on a lower dose?

First off, do you have a therapist you are speaking with regularly. If not, I would suggest that. The situation you are in is too much to go through alone. I say this both as a therapist and as a someone who has gone through times of significant depression.

In my experience there is an “sweet spot” at which tryptophan works best. If it’s too low you will not have the flu effect of the tryptophan and if you go too high you can get what’s know as a “reversal effect” where negative symptoms may come back. How did you dose the tryptophan and what if your current dose right now?

Current dose is 3000 mg tryptophan for the day. I have tried SAMe before many times and it doesn’t seem to work. I do have a therapist but there is only so much CBT I can do and it is getting harder to push the thoughts away.

I didn’t see any reference in your dosage page for 5-HTP on how to keep from developing a tolerance, as well as caution for over doing it and permanently depleting serotonin (as warned in other websites). What are your thoughts on that? Thanks!

Hi Sara, I have never experienced even long term 5HTP deleting serotonin levels. I usually have people figure out an optimal dose of 5htp stating at 50mg either 2x or 4x day and going up by 50mg per dose until they find their “sweet spot”. I rarely have people go higher than 300mg per dose. If people find a dose that works well for them I have then take it for at lest 3 months (often 6 months) and then have them do a trial off of it to see if they still need it. If they stay symptom free I suggest not starting again until they experience low serotonin symptoms.

Thank you for this post. I tried following your dosing PDF for Tryptophan, but I am confused by your instructions. In the explanation, you describe two doses, one at Mid-Morning (MM) and another at bedtime (BT).

But in the example that follows, you describe dosing 3x per day.

I have read Julia Ross and Trudy Scott’s recommendations, which also suggest dosing with Tryptophan only 2x per day.

Hi Chris, Sorry about the confusion on the times for taking tryptophan. Amino acids are often given 2x day. Tryptophan is traditionally given mid afternoon and bedtime. Sometimes people require more support, so if well tolerated, take tryptophan or 5htp 4x day (1st thing in the morning, mid morning, mid afternoon and bed). If someone becomes sleepy during the day when taking 4 doses of tryptophan we stop the 1st thing and mid morning doses.

I also tried tryptophan (500mg) on two separate occasions since I’m the anxious kind of low mood, but both times after a single 500mg dose, I fell asleep! Is my system just sensitive and I should try again at a half dose or does this prove it won’t work for me? I did try 5-HTP (50mg) at a different time but felt a little wired. Should I try less?

Hi Cassie, What time did you take the Tryptophan? Does sound like it was too much to take during the day. You could try a lower dose then. If you have sleep issues would be good at bedtime I would think. Best Dr. Josh

Hello, I experienced severe anxiety and depression three years ago. I didnt know what it was due to, at the time i was taking antacids and antibioitcs and I didnt know that had anything to do with it but I decided to stop all pills and just eat right and in two months I was fine. Three years later (not taking any pills) I was fine until I decided to take omeprazole again for 4 months ans suddenly it happened again…now I know for sure its the pills..and after researching im 100 percent sure its the anatacids. Im feeling alot better now but still have some anxiety and depression. I had from december 13 to january 8 IBS, nausea,brain fog,severe panick attacks with depression, couldnt focus/concentrate, cried out of nowhere,very dizzy about to faint once at a restaurant and saves myself drinking two cokes, very pale skin, felt weak and extremely tired. For 20 days ive been eating better,lots of protein and everyday i feel better and dont have those nightmare symptoms anymore. Its day 22 but i still a little off with anxiety and moderate depression. How long do you think I will feel normal again? Im convinces it was amino axid deficiency due to omeprazole cause i did bloodwork and my B vitamins were fine and iron. Thanks in advanced

I think I would see if you can facilitate the healing by adding full spectrum amino acid blend like Total Amino solution 1st thing in the morning and mind morning. I would start with 1 at each of those times and can work your way up to 2 or 3 caps at a time. These are bioavailable amino acids that require little to no digestion to be absorbed. It is amazing to me how disruptive PPIs can be to protein digestion and subsequently neurotransmitter production. Sounds like you are very sensitive and need to be mindful of finding more natural ways to manage your GI issues.